BackTable / VI / Podcast / Episode #158
Microwave Ablation for Liver Lesions
with Dr. Driss Raissi
Dr. Christopher Beck talks with Dr. Driss Raissi about his approach to Microwave Ablation of Liver Lesions, including workup, technique, and tips and tricks for a successful ablation treatment.
BackTable, LLC (Producer). (2021, October 3). Ep. 158 – Microwave Ablation for Liver Lesions [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Driss Raissi
Dr. Driss Raissi is the Chief of the Division of Vascular and Interventional Radiology with UK Healthcare in Kentucky.
Dr. Christopher Beck
Dr. Chris Beck is a practicing interventional radiologist with Regional Radiology Group in New Orleans.
In this episode, Dr. Driss Raissi and our host Dr. Chris Beck discuss the planning, technique, and follow-up considerations for microwave ablation of liver lesions.
First, they talk through the process of mapping out the tumor. Dr. Raissi often attends tumor boards to contribute to the variety of treatment perspectives and gain consensus for microwave ablation from colleagues in different specialties. He also discusses the differences between cirrhotic and steatotic livers because the latter can limit the efficiency of microwave energy delivery.
During the procedure, Dr. Raissi appreciates the simplicity of a one-needle device. He offers advice for maneuvering near critical organs: direct the tip of the needle towards the critical structure to gain control. Additionally, he prefers to align the long axis of the needle with the long axis of the tumor and to minimize the number of new liver punctured by overlapping ablation zones.
The doctors also discuss the need to balance clean margins with preservation of liver tissue, noting that lesions in different lobes can be treated in different sessions. Finally, they cover telehealth follow-ups and MRI follow-up during the subsequent month.
Throughout this episode, we refer to findings about microwave ablation from previous publications, which are linked below.
Comparison of microwave ablation and radiofrequency ablation for hepatocellular carcinoma: a systematic review and meta-analysis:
Liver microwave ablation: a systematic review of various FDA-approved systems:
Early Outcomes with Single-antenna High-powered Percutaneous Microwave Ablation for Primary and Secondary Hepatic Malignancies: Safety, Effectiveness, and Predictors of Ablative Failure:
[Dr. Christopher Beck]
Yep. So let's talk a little bit about margins. So actually, there's two things I want to talk about. I want to talk about results in a fibrotic liver and a fatty liver, but first, I wanted to talk about margins. So will you kind of talk about maybe, for the younger interventionalist or some of the trainees out there, you're trying to ablate the tumor, but also, talk about how margins play a role in your ablation zone?
[Dr. Driss Raissi]
Yeah. I mean, if you just go by the data, what does the data tell us? The data tells us if you're dealing with HCC, you need to ensure that you get .5 centimeter surgical margin. And if you're dealing with colorectal, you need one centimeter. And you can find data also that says, one centimeter for both, one centimeter for HCC and one centimeter colo-recs. But you know what? Where does that data come from? Where does that data come from? That data comes from surgical resection, open surgical resection where you have the benefit of looking right directly at the tumor or using beautiful high-resolution images of intraop ultrasound.
And I don't feel like anybody has ever raised that question, where is that data coming from? And why did I start asking myself that question? Because my surgeon started becoming super happy with me when I started, "Oh yeah, I gave you a two centimeter margin." And I thought they were going to be like, Hey Driss, take it easy, this guy doesn't have too much liver." No, no, they were cheering me up. There were like, "Oh, that looks great. That is awesome. That is beautiful."
With time, I mean, I've been doing this for a long time. They started seeing that this patient actually did rather okay. The extra centimeter didn't make them too sick. The extra centimeter ensured they didn't have very early recurrences or they never had any recurrences at all in that surgical bed, where some of my more junior colleagues may have had, let's just say and don't tell them, this is just between you and me, I'm hoping this is a secret...
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